Open Letter to the Commission on Care: Why Privatizing VA Healthcare Would be a Huge Mistake

WASHINGTON--()--Today, Paralyzed Veterans of America released the following open letter from Acting Executive Director Sherman Gillums, Jr. to the Commission on Care:

Today, an active duty service member who is medivaced from the battlefield or extricated from a crashed helo during training, and has suffered a spinal cord injury, one of the most devastating injuries a person can suffer, will likely begin the first step toward rehabilitation at a Department of Veterans Affairs (VA) spinal cord injury center under a memorandum agreement between Department of Defense (DoD) and VA. When I began the journey in 2002, I had no idea whether the VA care was superior to treatment at a military facility or in the private sector. But someone knew better than I did, and it was a good choice as I would come to find out later. In fact, left to my own devices, I would have likely opted to go to a private sector hospital based solely on what I had heard about VA hospitals, as is the case with many who rail against VA yet have never set foot in one as a patient.

But here is where the care in VA versus the private sector significantly differs. Before I got discharged from the VA hospital, I needed a home evaluation and assistance applying for the home structural alteration grant that would allow me to enjoy independence in my apartment. Most private sector facilities do not do that. I needed driving rehabilitation and assistance with obtaining the automobile grant, and I needed to have my van adapted so that I could get to my medical appointments, buy groceries, and parent my two young kids. Most private sector facilities do not do that. I needed to be educated on and assisted with filing a VA disability claim, which can be a long, arduous, and frustrating process when one has no idea how to proceed. No private sector facility does that. There were also times when I had questions about my care and had to seek the assistance of my accredited representative who understood my rights and could assist me with an appeal, if necessary. All this does not exist in the private sector.

For the last 13 years, I have remained relatively healthy despite my severe injury, largely due to the preventative care and annual examinations I have received at VA hospitals and spinal cord injury centers. There have been instances when I’ve had to seek care in the private sector using payer-only coverage, Tricare, mainly for emergency medical treatment. I entered these experiences with trepidation because I usually ended up with a doctor who recommended a course of treatment that I knew was wrong, or would not listen to me as I tried to explain my medical history without my records available. Often times, I would just submit to the treatment out of desperation, knowing in my mind that a VA spinal cord injury physician or nurse who knew my medical history and understood my complex disability picture would be available to remedy the situation later.

With these experiences in mind, I cannot fathom how those who claim to honor our nation’s veterans see this as a viable approach to caring for veterans with special needs. I am not saying that placing these veterans in the hands of providers in the private sector is a death sentence. But it does represent a complete deflection of responsibility to subject these men and women to an alternative "payer only" system of care that not only is ill-equipped to absorb the demand but is also, at best, minimally equipped in terms of expertise and the ability to coordinate such complex care over a veteran's lifetime. We know that VA is bursting at the seams in terms of its capacity to provide care for the 9 million veterans who are enrolled. We also know that it is Congress's responsibility to give VA the resources it needs to meet its mission, and Congress failed to do so.

A 2014 New York Times headline read: The Health Care Waiting Game, Long Waits for Doctors’ Appointments Have Become the Norm. Nowadays, one might assume this article refers to VA. Actually, it outlines how the Affordable Care Act had brought tens of millions of newly insured patients into a private sector system that was already poorly equipped to provide basic care. Or, as one health care economist put it, wait times were expected to go up because of expanded access to care without an expanded system of providers. In fact, VA is actually one of the only health care systems in the nation that openly tracks wait times and has standards for what they should be. Any deficiencies it now suffers are being compared against imaginary benchmarks, not the private sector, which some want to flood with veterans in need of timely healthcare.

So what happens when non-VA providers cannot absorb new demand as veterans are pushed to the private sector? What if private sector facilities game the waitlist numbers? We already know it can happen. Will the VA Inspector General have the authority to investigate in those circumstances? Will Congress have the authority to compel CEOs and directors of healthcare systems to testify and issue enforceable directives? Claims filed under Title 38 section 1151 hold VA accountable when medical care goes awry. Will veterans enjoy the same protection in private sector facilities in instances of medical malpractice with VA as the payer?

Until these and many other questions are answered, any discussion on eliminating the VA healthcare system, whether in 2 years or 20 years, is colored by what appears to be a circuitous attempt to "pass the buck" because the problem is simply too complicated to resolve. But this complexity is derived from questions that should not be easy to answer and require serious contemplation by those elected to lead our country, such as whether the direct costs of preparing for and fighting wars are worth paying? And what is our government's duty to those who served when the tremendous accrued costs come due long after the guns fall silent? Paralyzed Veterans of America maintains that our government cannot be allowed to outsource its obligation to fund, resource, sustain, and monitor the only system of healthcare equipped to take care of our most vulnerable wounded, injured, and diseased warriors.

Despite the problems that persist, the system cannot be allowed to devolve into standalone "centers of excellence" reliant on a fragmented framework of external supportive services instead of the coordinated, multi-disciplinary, tertiary functions that interdependently comprise and characterize the uniqueness of the VA system of care. Any plan proffered by the Commission on Care that atrophies those tertiary functions by ramping up demand for privatized care in the name of “choice” at the expense of the VA healthcare system is unacceptable. And it will bear foreseeable, irreversible consequences for a generation of veterans, maybe more, as our elected leaders enjoy spectator status when what happened at the Phoenix and Tomah VAs occurs next time in the private sector, outside the domain of their responsibility.

In closing, millions of service-injured, low income, elderly, severely or catastrophically disabled veterans have already made their choice — and they chose VA. If you blow it up, you're responsible for what is left in its place.

Signed,
Sherman Gillums Jr.
U.S. Marine & Paralyzed Veteran
Acting Executive Director, Paralyzed Veterans of America

Contacts

Paralyzed Veterans of America
Lani Poblete, 202-412-1709

Release Summary

Open Letter to the Commission on Care: Why Privatizing VA Healthcare Would be a Huge Mistake

Contacts

Paralyzed Veterans of America
Lani Poblete, 202-412-1709